Operative cholangiography has been undergoing an evolution since Mirizzi first advocated the routine use of operative cholangiography in Surg. Gynecol. Obstet., 65, 702 (1937). A variety of cannulas, clamps and catheters have been recommended for this purpose. Since the techniques to fasten the cannula to the cystic duct involve cumbersome manipulation, and frequently allow dye leakage or bubble injection, surgeons have been reluctant to employ this intraoperative diagnostic modality routinely during biliary surgery.
The objective in operative cholangiography is to inject radiopaque dye into the cystic duct of the gall bladder so that it passes into the common bile duct to opacify it to x-rays to facilitate detection of stones, tumors, strictures, anomalies and the like, during biliary surgery. The operative cavity is 10-15 centimeters in depth and it is difficult and time-consuming to effect a tie around the cystic duct to contain and seal a catheter for injection of dye.
The characteristics of an ideal cannula for operative cholangiography should satisfy such criteria as (1) insertion should be readily achieved; (2) the mechanics should not obscure vision during cannulization; (3) the method of securing the cannula should not be cumbersome or time-consuming; (4) there should be no significant resistance to flow of dye during injection; (5) connections should not leak; (6) surrounding delicate vital structures should not be endangered; and (7) no opaque foreign material should appear on the x-rays other than dye.
In Am. J. Surg., 123, 741 (1972) there is reported the use of a Fr. 5 Lehman radiopaque catheter fixed in position with a hemoclip. Such clips may interfere with future diagnostic modalities such as computerized radiographic or electro-magnetic tomography. More recent efforts to advance techniques and provide improved cannula and clamp devices for operative cholangiography are described in Arch. Surg., 111, 608 (1976); Arch. Surg., 112, 340 (1977); Arch. Surg., 113, 729 (1978); Arch. Surg., 114, 749 (1979); Arch. Surg., 115, 229 (1980); Am. J. Surg., 137, 826 (1979); JAMA, 246(4), 380 (1981); Medical Radiography and Photography, 57(1), 18 (1981); and references cited therein.
Several hundred thousand patients undergo biliary surgery annually in the United States. Many experienced surgeons agree that cholangiography should be performed routinely. There remains a need for improved means for operative cholangiography.
Accordingly, it is an object of the present invention to provide a novel surgical device which is adapted for cholangiography.
It is another object of this invention to provide a cannula and clamp device for operative cholangiography which is constructed substantially of radiolucent material.
It is a further object of this invention to provide a cannula and clamp device for operative cholangiography which can be applied and removed rapidly with single hand manipulation.
Other objects and advantages of the present invention shall become apparent from the accompanying description and drawings. Applications for angiography are contemplated with modified version of the same invention.
U.S. Pat. Nos. of general interest with respect to the present invention include 611,038 (1898); 2,234,686; 3,019,790; 3,166,819; 3,500,820; and 3,814,080.